Customs Declaration
· This form would be given to you inside the flight few hours before you are about to arrive. One form is enough for the parents. If needed, feel free to call the air hostess and ask for another form.
1. Family Name:
First (Given):
Middle:
2. Birth Date
3. Number of family members traveling with you:
4(a) U.S Street Address:
(b) City:
(c) State:
5. Passport Issued by (Country):
6. Passport Number
7. Country of Residence:
8. Countries visited on this trip prior to U.S arrival:
9. Airline/Flight No. or Vessel Name:
10. The primary purpose of this trip is business: Yes□ No■
11. I am (We are) bringing
(a) fruits, vegetables, plants, seeds, food, insects Yes□ No■
(b) meats, animals, animal/wildlife products Yes□ No■
(c) disease agents, cell cultures, snails Yes□ No■
(d) soil or have been on farm/ranch/pasture Yes□ No■
12. I have (We have) been in close proximity of
(such as touching or handling) livestock Yes□ No■
13. I am (We are) carrying currency or monetary
instruments over $10,000 US or foreign
equivalent:(see definition of monetary
instruments or reverse) Yes□ No■
14. I have (We have) commercial merchandise
(articles for sale, samples used for soliciting
orders or goods that are not considered
personal effects) Yes□ No■
15. Residents – the total value of all goods including
Commercial merchandise I/we have purchased
or acquired abroad (including gifts for someone
else but not items mailed to the U.S) and am/are
bringing to the U,S is: $□ Leave this blank
16. Vistors – the total value of all articles that will
remain in the U.S including commercial
merchandise is: $□ 120
Read the instructions on the back of this form. Space is provided to list all the items you must declare.
I have read the important information on the reverse side of this form and have made a truthful declaration
Signature Date
On back side of the form, there is a section where declaration of items can be made. Fill it up.
Description of Articles
Clothes $120
Total $120